Intravenous immunoglobulin therapy in COVID-19-related encephalopathy
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ORIGINAL COMMUNICATION
Intravenous immunoglobulin therapy in COVID‑19‑related encephalopathy Lorenzo Muccioli1 · Umberto Pensato1 · Giorgia Bernabè2 · Lorenzo Ferri1 · Maria Tappatà3 · Lilia Volpi3 · Ilaria Cani1 · Olivia J. Henry4 · Francesca Ceccaroni2 · Sabina Cevoli3 · Gloria Stofella3 · Elena Pasini3 · Giacomo Fornaro5 · Caterina Tonon1,3 · Simone Vidale2 · Rocco Liguori1,3 · Paolo Tinuper1,3 · Roberto Michelucci3 · Pietro Cortelli1,3 · Francesca Bisulli1,3 Received: 9 September 2020 / Revised: 17 September 2020 / Accepted: 19 September 2020 © The Author(s) 2020
Abstract Objective To report on efficacy and safety of intravenous immunoglobulin (IVIg) therapy in a case series of patients with COVID-19-related encephalopathy. Methods We retrospectively collected data on all patients with COVID-19 hospitalized at two Italian hospitals who developed encephalopathy during disease course and were treated with IVIg. Results Five patients (two females, mean age 66.8 years) developed encephalopathy after a mean of 12.6 days, since the onset of respiratory/constitutional symptoms related to COVID-19. Four patients suffered severe respiratory distress, three of which required invasive mechanical ventilation. Neurological manifestations included impaired consciousness, agitation, delirium, pyramidal and extrapyramidal signs. EEG demonstrated diffuse slowing in all patients. Brain MRI showed non-specific findings. CSF analysis revealed normal cell count and protein levels. In all subjects, RT-PCR for SARS-CoV-2 in CSF tested negative. IVIg at 0.4 g/kg/die was commenced 29.8 days (mean, range: 19–55 days) after encephalopathy onset, leading to complete electroclinical recovery in all patients, with an initial improvement of neuropsychiatric symptoms observed in 3.4 days (mean, range: 1–10 days). No adverse events related to IVIg were observed. Conclusions Our preliminary findings suggest that IVIg may represent a safe and effective treatment for COVID-19-associated encephalopathy. Clinical efficacy may be driven by the anti-inflammatory action of IVIg, associated with its anticytokine qualities.
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-10248-0) contains supplementary material, which is available to authorized users. Lorenzo Muccioli and Umberto Pensato have contributed equally to this work. * Francesca Bisulli [email protected] 1
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, Via Altura 3 40139, Bologna, Italy
2
Infermi Hospital, AUSL Romagna, Rimini, Italy
3
IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
4
Karolinska Institutet, Stockholm, Sweden
5
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Severe acute respiratory syndrome-coronavirus-2 (SARSCoV-2) is the causative agent of coronavirus disease-2019 (COVID-19). While many individuals with SARS-CoV-2 infection are asymptomatic or develop only mild respirat
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